BACKGROUND & AIMS: Radiofrequency ablation (RFA) is an established treatment for dysplastic Barrett's esophagus (BE). Although short-term end points of ablation have been ascertained, there have been concerns about recurrence of intestinal metaplasia (IM) after ablation. We aimed to estimate the incidence and identify factors that predicted the recurrence of IM after successful RFA. METHODS: We analyzed data from 592 patients with BE treated with RFA from 2003 through 2011 at 3 tertiary referral centers. Complete remission of intestinal metaplasia (CRIM) was defined as eradication of IM (in esophageal and gastroesophageal junction biopsy specimens), documented by 2 consecutive endoscopies. Recurrence was defined as the presence of IM or dysplasia after CRIM in surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings. RESULTS: Based on histology analysis, before RFA, 71% of patients had high-grade dysplasia or esophageal adenocarcinoma, 15% had low-grade dysplasia, and 14% had nondysplastic BE. Of patients treated, 448 (76%) were assessed after RFA. Fifty-five percent of patients underwent endoscopic mucosal resection before RFA. The median time to CRIM was 22 months, with 56% of patients in CRIM by 24 months. Increasing age and length of BE segment were associated with longer times to CRIM. Twenty-four months after CRIM, the incidence of recurrence was 33%; 22% of all recurrences observed were dysplastic BE. There were no demographic or endoscopic factors associated with recurrence. Complications developed in 6.5% of subjects treated with RFA; strictures were the most common complication. CONCLUSIONS: Of patients with BE treated by RFA, 56% were in complete remission after 24 months. However, 33% of these patients had disease recurrence within the next 2 years. Most recurrences were nondysplastic and endoscopically manageable, but continued surveillance after RFA is essential.
BACKGROUND & AIMS: Radiofrequency ablation (RFA) is an established treatment for dysplastic Barrett's esophagus (BE). Although short-term end points of ablation have been ascertained, there have been concerns about recurrence of intestinal metaplasia (IM) after ablation. We aimed to estimate the incidence and identify factors that predicted the recurrence of IM after successful RFA. METHODS: We analyzed data from 592 patients with BE treated with RFA from 2003 through 2011 at 3 tertiary referral centers. Complete remission of intestinal metaplasia (CRIM) was defined as eradication of IM (in esophageal and gastroesophageal junction biopsy specimens), documented by 2 consecutive endoscopies. Recurrence was defined as the presence of IM or dysplasia after CRIM in surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings. RESULTS: Based on histology analysis, before RFA, 71% of patients had high-grade dysplasia or esophageal adenocarcinoma, 15% had low-grade dysplasia, and 14% had nondysplastic BE. Of patients treated, 448 (76%) were assessed after RFA. Fifty-five percent of patients underwent endoscopic mucosal resection before RFA. The median time to CRIM was 22 months, with 56% of patients in CRIM by 24 months. Increasing age and length of BE segment were associated with longer times to CRIM. Twenty-four months after CRIM, the incidence of recurrence was 33%; 22% of all recurrences observed were dysplastic BE. There were no demographic or endoscopic factors associated with recurrence. Complications developed in 6.5% of subjects treated with RFA; strictures were the most common complication. CONCLUSIONS: Of patients with BE treated by RFA, 56% were in complete remission after 24 months. However, 33% of these patients had disease recurrence within the next 2 years. Most recurrences were nondysplastic and endoscopically manageable, but continued surveillance after RFA is essential.
Authors: Chin Hur; Sung Eun Choi; Joel H Rubenstein; Chung Yin Kong; Norman S Nishioka; Dawn T Provenzale; John M Inadomi Journal: Gastroenterology Date: 2012-05-21 Impact factor: 22.682
Authors: Robert A Ganz; Bergein F Overholt; Virender K Sharma; David E Fleischer; Nicholas J Shaheen; Charles J Lightdale; Stephen R Freeman; Ronald E Pruitt; Shiro M Urayama; Frank Gress; Darren A Pavey; M Stanley Branch; Thomas J Savides; Kenneth J Chang; V Raman Muthusamy; Anthony G Bohorfoush; Samuel C Pace; Steven R DeMeester; Viktor E Eysselein; Masoud Panjehpour; George Triadafilopoulos Journal: Gastrointest Endosc Date: 2008-03-19 Impact factor: 9.427
Authors: J J Gondrie; R E Pouw; C M T Sondermeijer; F P Peters; W L Curvers; W D Rosmolen; K K Krishnadath; F Ten Kate; P Fockens; J J Bergman Journal: Endoscopy Date: 2008-05 Impact factor: 10.093
Authors: J J Gondrie; R E Pouw; C M T Sondermeijer; F P Peters; W L Curvers; W D Rosmolen; F Ten Kate; P Fockens; J J Bergman Journal: Endoscopy Date: 2008-05 Impact factor: 10.093
Authors: Angelique Levert-Mignon; Michael J Bourke; Sarah J Lord; Andrew C Taylor; Antony R Wettstein; Melanie Edwards; Natalia K Botelho; Rebecca Sonson; Chatura Jayasekera; Oliver M Fisher; Melissa L Thomas; Finlay Macrae; Damian J Hussey; David I Watson; Reginald V Lord Journal: United European Gastroenterol J Date: 2016-07-07 Impact factor: 4.623
Authors: Kazuhiro Yasuda; Sung Eun Choi; Norman S Nishioka; David W Rattner; William P Puricelli; Angela C Tramontano; Seigo Kitano; Chin Hur Journal: Dig Dis Sci Date: 2014-01-07 Impact factor: 3.199
Authors: Kyle A Perry; Jon P Walker; Mario Salazar; Andrew Suzo; Jeffrey W Hazey; W Scott Melvin Journal: Surg Endosc Date: 2014-03 Impact factor: 4.584
Authors: Stefan Harmsen; Stephan Rogalla; Ruimin Huang; Massimiliano Spaliviero; Volker Neuschmelting; Yoku Hayakawa; Yoomi Lee; Yagnesh Tailor; Ricardo Toledo-Crow; Jeon Woong Kang; Jason M Samii; Hazem Karabeber; Ryan M Davis; Julie R White; Matt van de Rijn; Sanjiv S Gambhir; Christopher H Contag; Timothy C Wang; Moritz F Kircher Journal: ACS Nano Date: 2019-02-04 Impact factor: 15.881